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Thursday, May 07, 2009

To Test or Not

A distraught mother called me the other day. She wanted to know what she should do. Her third grade son is struggling in school, inconsistent performance, doesn't always "pay attention," not enjoying school at all. She's wondering, based upon conversations with the current teacher, if her son needs testing and has ADD. The only problems they see at home are related to homework completion.

I asked her some questions - how did he do in first grade? There were some concerns but they got through it. Second grade? No problems at all.

The red flags go up. What would you say to her? I'm interested in your thoughts before I share mine.

19 comments:

I"m not a learning specialist, and I don't claim to be. That said, how can there be "problems" one year, and not the next? Wouldn't there need to be a consistent pattern of learning challenges. I think this mother is not telling you everything. I would arrange to have the little guy undergo a full psycho-educational battery.

I would agree with Marcy. Seems like something is not being shared, either 2nd grade there were issues the school didn't share, or something is happening this year has made a difference. Time to get some data and find out what might be going on!

My first question would be, specifically, what difficulties is this student having, when, and in what subjects? Is there data to back up both academic and behavioral changes? Do they show any antecedents? Is there anything outside the realm of academics that could be affecting his performance? If he's struggling, have they started following their RtI process to determine if UDL strategies might help (followed by more intensive interventions backed up by data)?

I find myself wondering how he learns best, and if the method of teaching is meeting his needs. Is he gifted and bored with the content? I'm also suspicious of having some struggles in first grade, but none whatsoever in second. That could either be really, really good, or really, really bad. The 2nd grade teacher could have been teaching in a way that challenged this student while teaching in a way that really engaged him. Or, they could have just missed the boat completely and let him slip through the cracks.

OK, I've rambled quite a bit. I'm not an LD specialist, but it seems that there are a lot of questions to be asked prior to testing for ADD. Just my 2 cents.

Sometimes I wonder what the effect of playing video games has on the development of a child. Perhaps he has become much more interested in playing video games or something like that and now has more difficulty with his attention in the classroom because of a lack of stimulation.

I, too, agree with Marcy. It sounds like some information may be missing.

I would ask if the classroom environment is very different this year. Does this child like his teacher, his classmates? Is he finding the work too difficult or too easy? At the math center, seemingly small changes have had dramatically negative/positive effects on student performance and behavior.

Has this child shared his thoughts about school? I'd probably begin by talking with him first. If further tests are needed, they can be given next. I've seen a lot of students who appear to have ADD in one setting behave very differenly in others.

I always look at systems/environment first. What was different between these three classrooms.Every student I have ever seen does better with some teachers, in some rooms, than in others.

The complaints seem rather "typical boy" to me. School is often boring. It's a hell of a long time to sit in a room. Homework for primary students is stupid and worthless, who would want to do it?

So, my first guess is environmental, this teacher not meeting his learning and engagement needs.

But talk to the kid. A full battery of psych tests? please. That's torture for no apparent reason, why are so many adults so quick to impose those on kids? (Or why not have the teacher take personality tests? Might be more revealing. A good day with the MMPI etc will have he/she think twice before suggesting testing again.)

Anyway, about 2 years ago the NY Times and The Guardian (London) ran same day stories about kids adjusting to middle school. The Times, as is typical of Americans, recommended drugging the kids. The Guardian, more European, wondered about school architecture and time schedules and teacher training.

Of course, I kid. I'm going to join the chorus of voices who want to know what the environment is like, and how this year differs from previous ones. In addition to the good points already raised, we must also remember that individual teachers have different levels of tolerance for "inattention" (for lack of a better word), just as they do for other seemingly off-task behaviors. The possibility exists that the behaviors have been consistent over the last 3 years, but didn't concern the 2nd grade teacher the way they concern the 3rd grade teacher.

I also would not advocate for psychoeducational testing at this point, primarily because I don't think it would tell us anything we don't already know. If anything, maybe some quick (i.e., administered in class by the teacher) reading maze or other CBM to determine skill level relative to what's being taught (to address Colleen's concern), but still, not before looking at other environmental factors.

I'm going to piggyback off of one of Ira's comments here (and I say this as both a psychologist and a teacher) - many of the behavioral interventions I've written have dealt as much with teacher behavior as student behavior.

Thank you all. This was exactly the type of conversation I was hoping would occur. Full disclosure - the child is my nephew so I know him well. There is no withholding of information. At home, there are few issues other than, as Ira states, "typical boy" behavior.

Dave's comments re: RtI (response to intervention) and Ira's and Damian's re: the environment and teacher's role are important in my view. When we observe variability from year to year, what role does the teacher play? Are the curriculum/teaching methods the disability? Is there good teaching that incorporates Universal Design for Learning principles (UDL = good teaching) occurring in the classroom? Damien says, "many of the behavioral interventions I've written have dealt as much with teacher behavior as student behavior." The second grade teacher was a former pre-school teacher so I have to assume she had a more "developmentally appropriate" teaching style which supported my nephew's learning more effectively than the current teacher. Is the third grade teacher ready to evaluate her own methods of instruction and knowledge acquisition?

The update is the mom called the pediatrician and they are going to have a consultation to discuss the issues. I'm pleased to hear she did not automatically refer him for testing.

No one is saying the teacher is causing learning difficulties. What's being said is that there is a misalignment in the junction between teacher and student and that misalignment mimics an organic learning problem. The "learning difficulty" is situational; when the student is taught in a manner that corresponds with his style of learning there is no "learning difficulty," and no "teaching difficulty" either.

@Marcy That's not a conclusion I'd leap to (doing so would be akin to leaping directly to OMG MEDICATE), but the teacher is a part of the environment, and therefore must be considered (I almost called the teacher a 'data point', but decided that was too impersonal for a blog comment).

It's not necessarily that the teacher is a "bad teacher" who is entirely at fault; could be an issue of overall classroom management, could be the teacher is inexperienced, could be that the teacher is trying, but hasn't figured out, how to engage the child. Could be the teacher is genuinely trying, but just getting it wrong through no malice of his/her own. It happens, and there's no shame in that.

Then again, it could be a number of other factors (or combination thereof) that have little to nothing to do with the teacher. All I'm saying is that we have to look at all possible contributing environmental factors (including direct antecedents of the behavior, which may or may not involve the teacher), of which the teacher is one (and the fact that over the last three years, the teacher is a variable, makes it all the more important to look at, I think).

On the other hand, and I know nobody likes to say this, but there are bad teachers, or teachers who don't care, or teachers who have unrealistic or unreasonable behavioral expectations of children. There are teachers who present as hostile toward children who don't meet their particular vision of what a kid in school should look/act like.

I don't entirely know what to do about folks like that, quite honestly. I wish I did.

But putting that aside, let me throw out a f'rinstance: turns out the kid is mostly inattentive in, say, reading/LA. We give a CBM or some such, turns out he reads at a 9th grade level and is bored out of his mind reading 3rd-grade-level stories. Turns out it had nothing to do with the teacher, but rather the material was several years below his ability level. Wouldn't you be bored and possibly agitated if someone made you do that? If that were my kid, I'd much rather the school investigate than tell him to suck it up.

The same could be said for a student who is lacking in skills, and the material is far over his head. In either event, it's not necessarily LD, and it's not necessarily ADHD either. The answer was "None of the above", and because the school intervenes, they are able to provide the kid a more appropriate educational program (maybe a G/T class or something similar).

It's not about assigning blame; it's about finding the root cause of a problem and intervening before small problems become big ones.

In addition to all of the above, teaching style, environment, boredom, learning challenge, ADHD etc. the expectations on learners change each year, 3rd grade begins the first year of mandatory testing in MA, and the classroom milieu changes from learning how to learn, to learning how to test, the transition from learning to read to reading to learn begins, and many other subtle or not so subtle changes happen that make school much more "high stakes." It is seldom easy to simply say it's the kid, the teacher, the curriculum, the disability, the phase of the moon, or the sugar content of the food.

My son has years that go very well (Bs and As) and years that are very difficult (Cs and lower). I will not hear from a teacher for an entire grade and then hear weekly in another grade. The difference? If the teachers write assignments down (or get him to), and provide clear criteria and guidelines he does well. If they expect that simply by explaining assignments orally he will remember and complete them to verbally stated criteria he does poorly. If they say "your desk is always such a mess" he does poorly. If they say "Time to clean out your desk kiddo" he does better. While my daughter enjoys some teachers and teaching styles more than others she consistently does well. Some kids can adapt and adjust to the teachers' teaching style. Others not so much. If as educators our goal is to increase success rates we need to differentiate so that all kids can achieve success. We need to stop doing things the same and expecting different results.

I have taught many students who haven't had problems in second grade, but begin to struggle in third grade. I know that third grade in our school is so different from second grade. My students have many opportunities during the day to be up out of their seats working in groups and being active with their learning. Our third graders are expected to sit in their seats all day, complete many workbook sheets and be almost totally independent. I think our third grade teachers have a different mind set toward learning.

I'm wondering if the teacher is already doing things in class to help this student focus. For instance, I had a similar student who would not sit down. If he sat, his math problems were incorrect. If I let him stand, he got them correct. So, I placed him in the back of the room and told him that he had a designated area to "roam" as long at the work got done. He did great on his assignments and his standing/roaming was never a problem.

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